d t2261 programmatic environmental checklist（d t2261编程环境检查表）（7页）.docVIP

PROGRAMMATIC ENVIRONMENTAL CHECK LIST Wisconsin Department of Transportation DT2261 12/2006 Project ID County Funding Source ????? ????? State Only Federal Project Termini/Location ????? Estimated Project Cost - Include R/W Acquisition ????? Name of Facility to be Improved ????? Facility Classification ????? R/W to be Acquired ????? Total Acres ????? Fee Simple Acres ????? Permanent Easement Acres ????? Temporary Easement Acres Number of Buildings Acquired None ????? Vacant Buildings ????? Occupied Buildings Name of Individual Completing this Form ????? Date ????? Based on current knowledge of the proposal, I certify that to the best of my knowledge, the conditions, concerns, and issues reported on this checklist accurately reflect those affecting and affected by the proposal. (Signature) (Date) ????? (Name) ????? (Title) ????? (Organization) Description of Proposed Action - Insert project location map and other appropriate exhibits.  A. Right-of-Way Acquisition Right-of-Way may be acquired by fee simple purchase, permanent or temporary easement, right of entry, gift or other device 1. Will additional right of way need to be acquired? No R/W acquired. Proceed to item B Yes – R/W to be acquired. It is strongly recommended that input be sought from real estate interests to identify issues (if any) and costs. 2. Indicate type of improvement Reconditioning (Go to question #3.) Pavement replacement (Go to question #3.) Resurfacing (Go to question #3.) Bridge rehabilitation (Go to question #4.) Minor bridge replacement (Go to question #4.) 3. For reconditioning, pavement replacement, or resurfacing projects (3R projects), sites meeting the one-half acre test must have an archival and literature search conducted to confirm there are no archaeological sites or historic buildings or structures affected by the project. See FDM Procedure 26-5-1 Will the project acquire less than 1/2 acr